Thermal assessment statement for a detached house
GENERAL INFORMATIONS
Auditor general
information
Name
First name
Date of visit Statement No.
General customer
information
Name
First name
Phone Number
E-mail address
Number of people
in the hearth
Tax income
Address
Construction date
Altitude
m
Occupancy of
accommodation
for over a year for less than a year
Comfort level
winterbad
OK Good
summerbad
OK
Good
Client goals
Improve thermal comfort
Beautify housing
Save money
Increase the value of the property
Adapt / rearrange the accommodation
Reduce the environmental footprint Solve a
breakdown / deterioration
Recommendations
(to be completed at
end of visit)
Change of heating mode CAP A/
E CAP A/A
Pellet boiler
Other:
Gesture of isolation
ITE/ ITI
Low floor
Lost attics
Crawlers
DHW mode change
Thermodynamic balloon
I
Individual solar water heater
I
Installation of a ventilation system
CMV Hygro B CMV Hygro A
Comments:
Translated from French to English - www.onlinedoctranslator.com
High floor configuration
Floor type
high
Lost attics Converted attic Terrace roof
Big work
Wood Concrete or earth
Ceiling I don't know
Insulation
None > 10 years 5 to 10 years <5 years
Insulation thickness
cm
I don't know
If convertible attic
inform
Surface of crawlers
Exterior ceiling surface
If attic lost
to inform
Attic area
lost
Unrolled insulation Blown Insulation
Pphoto
HIGH FLOOR PHOTO
Comments
Configuration of exterior walls
NORTH FACADE
Composition of the exterior wall
Big work
Rock
Concrete
Masonry local stones
Concrete block
Grindstones
Bottom ash concrete
Hollow Brick
Other:
Formed concrete
Aerated concrete
Brick
Solid brick
Honeycomb brick
Earth
Drink
Rammed earth
Plank
Cob / Wood pan
Timber frame
wall thickness
cm
I don't know
5 to 10 years
Insulation
None > 10 years
<5 years
I don't know
Thickness
insulating
cm
I don't know
Orientation of the
facade
NE N NO
Dimensions of the wall
outside
Height
mLength
m
Surface
Adjoining area
If presence of sub-facades, or if non-
rectangular facade, fill in
Area 2 Area 3 Area 4
Sprocket
Total surface of the
facade
Area to be insulated
ITE/ITI
Pphoto
Census of openings
Kind
opening
No. L(m) H(m) Frame Glazing Shutter
Pphoto
Comments
Fenêtre
Bois
Fenêtre
Fenêtre
Fenêtre
Fenêtre
Fenêtre
Fenêtre
Fenêtre
Fenêtre
Fenêtre
PVC
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Configuration of exterior walls
EAST FACADE
Composition of the exterior wall
Big work
Rock
Concrete
Masonry local stones
Concrete block
Grindstones
Bottom ash concrete
Hollow Brick
Other:
Formed concrete
Honeycomb brick
Aerated concrete
Brick
Solid brick
Earth
Drink
Rammed earth
Plank
Cob / Wood pan
Timber frame
wall thickness
cm
I don't know
5 to 10 years
Insulation
None > 10 years
<5 years
I don't know
Thickness
insulating
cm
I don't know
Orientation of the
facade
NE E
ES
Dimensions of the wall
outside
Height
m
Length
m
Surface
Adjoining area
If presence of sub-facades, or if non-
rectangular facade, fill in
Area 2 Area 3 Area 4
Sprocket
Total surface of the
facade
Area to be insulated
ITE/ITI
Pphoto
Census of openings
Kind
opening
No. L(m) H(m) Frame Glazing Shutter
Pphoto
Comments
Fenêtre
Aucun
Fenêtre
Fenêtre
Fenêtre
Fenêtre
Fenêtre
Fenêtre
Fenêtre
Fenêtre
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Configuration of exterior walls
SOUTH FACADE
Composition of the exterior wall
Big work
Rock
Concrete
Masonry local stones
Concrete block
Grindstones
Bottom ash concrete
Hollow Brick
Other:
Formed concrete
Honeycomb brick
Aerated concrete
Brick
Solid brick
Earth
Drink
Rammed earth
Plank
Cob / Wood pan
Timber frame
wall thickness
cm
I don't know
5 to 10 years
Insulation
None > 10 years
<5 years
I don't know
Thickness
insulating
cm
I don't know
Orientation of the
facade
N/A S
ES
Dimensions of the wall
outside
Height
m
Length
m
Surface
Adjoining area
If presence of sub-facades, or if non-
rectangular facade, fill in
Area 2 Area 3 Area 4
Sprocket
Total area of
the facade
Area to be insulated
ITE/ITI
Pphoto
Census of openings
Kind
opening
No. L(m) H(m) Frame Glazing Shutter
Pphoto
Comments
Fenêtre
Aucun
Fenêtre
Fenêtre
Fenêtre
Fenêtre
Fenêtre
Fenêtre
Fenêtre
Fenêtre
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Configuration of exterior walls
WEST FACADE
Composition of the exterior wall
Big work
Rock
Concrete
Masonry local stones
Concrete block
Grindstones
Bottom ash concrete
Hollow Brick
Other:
Formed concrete
Honeycomb brick
Aerated concrete
Brick
Solid brick
Earth
Drink
Rammed earth
Plank
Cob / Wood pan
Timber frame
wall thickness
cm
I don't know
5 to 10 years
Insulation
None > 10 years
<5 years
I don't know
Thickness
insulating
cm
I don't know
Orientation of the
facade
N/A Y
NO
Dimensions of the wall
outside
Height
m
Length
m
Surface
Adjoining area
If presence of sub-facades, or if non-
rectangular facade, fill in
Area 2 Area 3 Area 4
Sprocket
Total surface of the
facade
Area to be insulated
ITE/ITI
Pphoto
Census of openings
Kind
opening
No. L(m) H(m) Frame Glazing Shutter
Pphoto
Comments
Porte
Bois
Fenêtre
Fenêtre
Fenêtre
Fenêtre
Fenêtre
Fenêtre
Fenêtre
Fenêtre
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Double vitrage ancien (>10 ans)
Volets battants PVC
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
Aucun
ARCHITECTURE - DESCRIPTION OF THE BUILDING
General configuration of the house
Living space Unheated surface Ceiling height
Basement
Ground floor
1erstage
2nd Floor
3rd floor
Living space
total
Burial of sub-
floor
Unburied
Buried
Semi-buried
Housing shape
Compact Elongated L-shaped
U-shaped
Other:
Low floor configuration
Low floor type
On basement
Crawl space On land
Fat-
work
Wood
Concrete or earth
Brick
I don't know
Insulation
None
> 10 years
5 to 10 years
<5 years
I don't know
Insulation thickness
cm
Bottom floor area
Area to be insulated
Picture
LOW FLOOR PHOTO
Comments
VENTILATION
Ventilation system
By infiltration High grids
and bass
Simple CMV
Auto Flow
VMC Double
Flow
CMV Hygro A
CMV Hygro B
Number of pieces
Number of bathrooms
HEATING SYSTEM and DHW
Energy
Fuel oil Gas Propane Wood Electricity
Coal
Generator
High T° boiler Electric
convectors
Low T° boiler
Wood stove Insert
Condensing boiler
Fireplace
of
heating
Year Rated p.
Yield p.
nominal
Placed in a heated volume
Characteristic
s
Yes No
Picture
Emission system
Cast iron radiator Steel radiator Fan coil
Underfloor heating Other:
Heated area
by the show
Cast iron radiator Steel radiator Fan coil
Heated floor Other:
Heated area
by the show
Cast iron radiator Steel radiator Fan coil
Heated floor Other:
Heated area
by the show
Pphoto
Comments
DHW production
Instant
Generator
heating
Gas water heater
Other:
Accumulation
Generator
heating
Gas water heater
Water heater
electric
Balloon
thermodynamics
Other:
Volume
ECS seniority
Placed in a heated volume
Pphoto
Yes No
Electric meter
Single phase Three-phase
meter power
Pphoto
< 5 ans
18 kVA